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Neuromodulation. 2019 Sep 6. doi: 10.1111/ner.13044. [Epub ahead of print]

Association Between Pain Scores and Successful Spinal Cord Stimulator Implantation.

Author information

1
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
2
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
3
Department of Anesthesia, Critical Care and Pain Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
4
Department of Anesthesia, Critical Care and Pain Medicine, Division of Pain, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Abstract

INTRODUCTION:

Determining reduction in pain score during spinal cord stimulation (SCS) trial is important prior to permanent SCS implantation. However, this association remains elusive. We investigate the association between post-SCS pain scores and successful permanent SCS implants.

MATERIALS AND METHODS:

This IRB-approved, retrospective study identified patients who underwent SCS trials and implantation. Predictive modeling with nonparametric regression and margins plot analysis was used to determine the threshold for post-SCS trial pain scores associated with successful permanent SCS implant (defined as >50% pain relief). Nonparametric sensitivity and specificity analysis was performed. p < 0.05 was considered significant.

RESULTS:

Eighty-eight patients with SCS trials were retrospectively identified (57.95% female, median age 52.5 ± 15.5 years). Of the total cohort, 79% had successful permanent SCS implantation. Post-SCS trial pain scores less than or equal to 4.9 had greater than 50% probability of a successful permanent SCS implant (97.14% sensitivity, 44.44% specificity, ROC = 0.71). Post-SCS trial pain scores between 4 and 7 were associated with a significantly higher probability of a successful SCS implant among patients without spine surgery compared with those with a history of spine surgery. Compared with males, females with pain scores between 5 and 7 had a higher probability of a successful SCS implant.

CONCLUSION:

Low pain scores after SCS trial are predictive of successful SCS implants with high sensitivity. Males and surgical patients with higher pain scores had a lower probability of successful SCS implant than their counterparts. Larger studies are needed to further elucidate this relationship.

KEYWORDS:

Gender and spinal cord stimulator; pain scores; prediction; spinal cord stimulation; spinal cord stimulation trial

PMID:
31489751
DOI:
10.1111/ner.13044

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